A Clinical Trial Of The Effects Of Preoperative Nicotine Patches On Postoperative Pain In Nicotine-dependent Patients

Background:About 230 million adults worldwide need surgery each year,and patients who receive surgery in hospitals must stop smoking before surgery,so about30 percent of patients undergoing surgery are nicotine addicts.The main symptoms of nicotine withdrawal syndrome are irritability,irritability,anxiety,impatience,dizziness,mild headache,dry mouth,insomnia,restlessness and inattention.Multiple clinical studies have shown that smokers experience more postoperative pain and need more opioid analgesics than nonsmokers.The main treatment principle of nicotine replacement therapy is to provide some of the original nicotine from cigarettes in a non-cigarette form,thus reducing the withdrawal symptoms of smoking cessation.The purpose of this study was to observe whether continuous administration of nicotine by nicotine patch after smoking cessation could reduce the dosage of postoperative analgesics and reduce adverse reactions.Methods:This was a randomized,double-blind,controlled trial.From September1,2018 to March 30,2020,a total of 80 patients underwent liver tumor resection due to liver occupation in the eastern hospital of hepatobiliary surgery of the naval military medical university.They were randomly divided into two groups,with 40 patients in each group.The nicotine patch group was applied daily from admission to the second day after surgery,and the blank patch control group was applied daily from admission to the second day after surgery.From admission to operation day,weight and blood pressure were recorded at 8 o 'clock each day,and Minnesota scale and smoking craving scale were scored.The CO content of exhaled gas,electric pain threshold and Von Frey pain threshold were tested when entering the operating room.All patients were given a uniform anesthesia program,and the postoperative analgesia program was PCIA,Sufentanil and metoclopramide were diluted to 150 ml with normal saline,and postoperative analgesia began 15 minutes before the end of the operation.Parameters were set: the first dose was 3ml,the background dose was0ml/min,the bolus dose was 1.5ml(0.06ug/kg),the locking time was 5min,and the1-hour extreme limit was 9ml;Before the operation,patients and their families were informed that when the VAS score of the patient was ?4,the analgesic pump should be pressed.If the VAS score of the patient was not relieved after pressing,the analgesic pump could be pressed again after 5min until the VAS score was ?3.The dosage of analgesia pump(ml)was calculated 1,24 and 48 hours after the operation.Pain score,nausea score,vomiting score,sedation score,and patient satisfaction score were calculated 1,24,and 48 hours after surgery.Itching,rash,skin lesions,chest tightness,dizziness,postoperative blood routine,liver function,renal function and coagulation function,and other adverse reactions or postoperative complications were recorded.Results :There was no difference between the two groups in general condition,demography,smoking history and baseline analysis.There was no statistically significant difference between the two groups(P>0.05).The electric pain threshold,Von Frey sensory threshold and Von Frey pain threshold of the nicotine patch group were all higher than that of the blank patch group(P<0.05),with statistically significant differences.There was no statistically significant difference in PCA consumption and the number of PCA compressions 1 hour after surgery,while the number of PCA consumption and the number of PCA compressions in the nicotine patch group were lower than that in the blank patch group at 24 and 48 hours after surgery,showing statistically significant differences.VAS scores of rest and activity showed no statistical difference at 1h postoperatively,while those of nicotine patch group were lower at 24 h and 48 h postoperatively than those of the blank patch group,and the difference was statistically significant.Conclusion: In this study,it was found that preoperative pain threshold was reduced after nicotine withdrawal,resulting in hyperalgesia,while the nicotine patch may improve hyperalgesia after nicotine withdrawal.Nicotine patch replacement therapy after smoking cessation can improve hyperalgesia,reduce the amount of postoperative analgesics,and reduce postoperative VAS score.